How would you post-operatively manage a peripheral stage I small cell lung carcinoma s/p upfront wedge resection with an R1 microscopic positive margin along the staple line and visceral pleural invasion?

2020 ASTRO SCLC guidelines state under KQ1 Table 3. For postoperative patients with LS-SCLC and R1 or R2 resection, postoperative RT is conditionally recommended."

If you would advise PORT, what should be the CTV and dose/fractionation?

Answer from: Radiation Oncologist at Community Practice

I would advise 4 cycles of chemotherapy followed by immunotherapy. It would be hard to define a “reasonable radiotherapy target” with visceral pleural involvement and surgical suture line, which is true in NSCLC as well. I would not recommend thoracic or prophylactic cranial radiotherapy...

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How would you post-operatively manage a peripheral stage I small cell lung carcinoma s/p upfront wedge resection with an R1 microscopic positive margin along the staple line and visceral pleural invasion?

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